Below is an email I received. Icd9 has 9,000 codes, icd10 will have 100,000 codes. Anybody really think this will make anyone healthier? It will just create more costs, paperwork, and games. Our doctors have become documenters. Check the boxes and get paid.

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Hopefully, your practice is already in full gear getting ready for the switch to ICD-10. However, updates to ICD-9 went into effect in October, and offices still have to do plenty of coding before the transition in October 2013.

According to Contexto Media, some of the 2012 changes to the ICD-9-CM set include the addition of a code for unspecified Dementia (294.2) and an update to influenza caused by the identified 2009 H1N1 virus. See more here. Additionally, the full list of updated codes – plus a variety of other coding resources – is available on the Centers for Medicare and Medicaid Services website.

With all the simultaneous changes to coding rules – ICD-9 updates, ICD-10 training – it can be easy to get overwhelmed. In a white paper, the Coding Institute warns that practices that bill Medicare payers will start seeing denials from Modifier GZ much more quickly.

Modifier GZ indicates that a physician provided a service that wasn’t covered by the patient’s plan and was not pre-approved with an advance beneficiary notice (ABN). Unfortunately, using this modifier won’t make up for lost revenue. But it’s still necessary because it clears the practice of fraud and/or abuse charges.

“By appending this modifier, you’re telling Medicare that you know you performed a non-covered service and you know they aren’t going to pay for it,” the Coding Institute says.

While proper coding right now is a top concern, companies also need to set aside enough time and money to cover training for the transition to ICD-10. According to a study from the Journal of the American Health Information Management Association, health information managers who have already prepared budgets are expecting costs much higher than those that have only set estimations.

Out of the 600 HIM professionals, 39 percent of those who are already budgeting for ICD-10 training expect costs to be on the high end, while just 27 percent of respondents with no financial plan believe it will be expensive.

“Although direct and intensive individual coder training on ICD-10-CM/PCS is not recommended until early 2013, related expenses will occur sooner, including knowledge gap analyses, anatomy and physiology training or refreshers, and outreach to educate non-coder staff on the ICD-10 conversion and its impact,” the researchers concluded.

Don't bother doc...this is definitely the wrong venue for that. We have too many mini-obamas in this thread.

Most people think doctor=millionaire. They begrudge doctors because they "make so much" and ignore the $25 bill they receive in the mail (copay/deductible/whatever). They do this whilst the doc puts in enormous hours and is constantly on call. The advent of the EMR system added an average of an hour a day to the physician schedule.

However, everyone forgets that doctors put in many years of schooling and accrue a helluva lot of debt.

Today, the ins co's have all of the power. Most docs havent received a raise in YEARS. When a doc goes to complain to the ins co's about this, he is told to get lost...take it or drop out of the plan. This is why alot of docs are joining larger groups (since they have more power with the ins co). To keep up with this trend of no raises, the doc has to see more patients and have expanded hours. After all, his expenses keep going up year after year. Obviously this leads to watered down medical care and unusual wait times to see the doc.

Another thing not known about your average person is the medical billing aspect of the business. IT IS ATROCIOUS. Docs are probably losing 10-20 PERCENT because of bad billing. Never mind the fact that the front desk should be verifying pt insurance, get referrals and auths...etc etc. I've been in the business for 12 years, I only wish I had gotten into it 5-10 years before that.

Guys, the doc is running a business. Respect that.

I agree...ICD-10 is an aberration. I'm going to bet you that the date will be pushed further back (maybe 2014-15).

Most softwares should be able to take an icd-9 and have the equivalent icd-10 doled out.

I am not a doctor and wouldn't want to be. There are not rich. They work their asses off and are always under the threat of a lawsuit too. How many other people have jobs like that? Patients are demanding, on call for free, and Even complain about copays.

Insurance companies are pure evil. The less they pay docs, the more they keep. They dictate healthcare. They try to make it as difficult as possible to get reimbursed. Doctors have sold their collective soul to them. Insurance companies pay more for a lab test than an office visit.

None of the doctors I work with want their kids to,follow suit. That should tell you something.

Plenty of doctors want their kids to be doctors, stop being a drama queen.

I agree it will pushed back. Medical offices are notoriously behind implementing technology.

You can always put things into a general category. It really does show though what happens when administrators take over. Can't wait for icd11.

Thank you troll.

It's not a troll, it's the damn truth. And it's highly likely (Read: 99%) you're completely making **** up about no doc you know wanting their kid to be a doc. You're not the only one ITT familiar with the medical industry.

Of course not everyone. It was a generalized statement that didn't need your two cents thrown in.

And I am sure others have a lot of medical knowledge...much more than I do.

And I value other people's opinion outside the medical field too. Love hearing the prospective of others.

I do run a practice full of internal medicine, dermatology, Ob/gyn, radiology, Gastro, family practice, physical therapy, workman's comp, nutritionist, ophthalmology, etc so I have wide perspective. We see 500 patients a day. A lot of the doctors are my best friends. I know their lives as well as the administrators.

It is a challenging exhausting business. I describe it as the DMV of sick people.

Regards

On average how many patients does each doctor see a day?

20 at the low end and 60 at high end. Average is 30. About 3 an hour.

*Quick edit, this post is made assuming your claiming that becoming a PCP doesn't need that much education, if your just saying you want to make more money then thats a perfectly reasonable personal choice


(This is coming from someone who plans on specializing because I want to do academics)

This post makes it pretty obvious that your not in medical school yet, the general public (pre-meds included) don't understand the scope of what PCP's do in practice. Yes, midlevels are being used to "replace" some FM MD's, but in the vast majority of situations these midlevels are working in a group practice that has FM MD's that handle the groups more complex patients.

If you leave urban or upscale suburban areas its common to have FM docs delivering babies (including C-sections), caring for neonates in the nursery, doing colonoscopies, treating their patients when admitted to hospital for DKA/pneumonia/etc. (including ventilation management for intubated patients) and staffing ERs in addition to their normal outpatient practice.

Even in suburban/urban settings, its still really common for FM docs to deliver babies, do tons of gyn care, spirometry, EKGs, joint injections, laceration and fracture care, tons of dermatology (excisions/biopsies), psychopharmacology, etc. And of course managing extremely complex patients where you can't just focus on one organ system and punt them back to the PCP like specialists do.

In all settings, one of the most important jobs of a PCP is helping patients make complex health decisions, when patients visit specialists (cardiology has been catching a lot of heat lately for unnecessary angioplasty) they tend to get rail roaded into interventional treatments because when you get paid to swing a hammer, everything looks like a nail. You need to have extensive medical knowledge to help your patients only get treatments that are actually indicated given your long term knowledge of a patient's history.

In the army during sick call, docs were able to see 20 to 30 troops an hour.

We need a new model for seeing patients. One which is more efficient.

In the future when man and machines merge. There can be a computer chip on the back of our necks with our medical history. Should save time on paperwork.

When it comes to cost efficiency, BY FAR the least efficient parts of the healthcare system involve going to the ER and being hospitalized. Preventing one unnecessary trip to the ER or hospitalization can literally save the system 100s of thousands of dollars. If you want to save the system money, you want LONGER outpatient visits where the docs are seeing LESS patients, but are able to better prevent hospitalization.

That is crazy. How can someone make an accurate assessment in 2 minutes? I presume the nurses do a lot of work, but still...

A good doctor is also trying to assess other issues which they did not come in for. They also need time to review family history.

What many people don't realize is how much time it still takes AFTER the patient leaves. You need to review lab results, add an assessment and then seal the chart.

You're completely missing the forest for the trees. The vast majority of PCP work is basic ****. Come in for an earache, get antibiotics. There's no reason to have that part of the job done by somebody who did their residency in internal medicine.

The whole point is to leave the easy stuff to people who aren't trained as well to bring down costs and allow PCPs to focus more on the hard cases.

From 2 sets of expereinces, I'm very familiar with how important a PCP can be in a complex case. However, I've been to the doctor for an sinus infection way more, and I am sure it's a amazingly straightforward diagnosis.

In the future computers would be able to perform those duties.

First off, do you know the differences between a IM PCP doc and a FM doc?

My point is that in most group primary care practices today, they have NP's/PA's doing the adolescent sinus infections and the PCP MD's are doing more of the stuff I talked about. Pre-Meds get this attitude about primary care docs because we are (almost always) young and relatively healthy. Its obviously pretty easy to treat a young and healthy person, but you are not the average patient of your primary care doc.

Also, I agree that Internal Medicine docs are not optimally trained to be doing primary care given the fact they don't do OB/GYN or Peds training in residency and hardly do any muscle/skeletal training, so they are really not able to care for significant portions of the population compared to a Family Medicine trained doc. But given the shortages of primary care providers, IM docs doing primary care are obviously really important.

Yup I do, and again, you're completely missing the point.

I'd buy that many pcp groups use NP/PAs, but there simply aren't enough NP/PAs around to handle the basic stuff (There were only 75k PAs and 125k NPs in 2008). Considering a lot of a PCPs work is basic and we have a huge shortage of them, then there should be a ton more. The current number of PCPs sits around 350k. Ideally, the number of PAs and NPs are greater than the number of PCPs.

Again, the point is that many doctors end up doing a ton of basic work that doesn't require massive amounts of training. That doesn't mean that Family Medicine docs are worthless, as you seem to think I'm implying, but that the current system we have set up is horribly inefficient.

A chimp, well a smart one, could do 75% of the stuff I do.

You really need me for the other 25% though.

You can teach a monkey to do surgery, but its hard to teach one not to do surgery

I think a lot of MDs would disagree with this, but I guess since it is just a matter of what someone considers "basic" there isnt a concrete answer.

I do think you will come to appreciate more of the complexities of even something that appears "basic" as your start going through medical school. And its not just about the science being complex, its the fact that your trying to help a person not just fix a machine. There are tons of terrible doctors, and not many of them are bad because they lack scientific knowledge.

Dude, try arguing from something other than a false sense of authority.

NPs and PAs are more than ready to treat patients basic needs. They should be the first line of 'defense' in medical treatment and their use should be greatly expanded. Ironically, you point out the reason why. The science isn't the hard part. MDs and DOs are differentiated by NPs and PAs by their massive scientific training, they most definitely are not superb at 'treating the person, not the machine.' Since this person, not machine stuff is a massive part of a basic doctor visit, well, that's kind of the whole point.

Im not arguing anything lol, my last post was saying some people disagree with you while others agree with you! (Even from my first post on this subject I mentioned that NP/PA should be handling simple things)

The second half of my post was just encouraging you in your medschool endeavors and pointing out that the science isn't the only thing we are here to learn.

How are your interviews going? For me it was such a drag having to fly out to interviews every week while still keeping up with engineering projects, bleh.

Well, considering I haven't gotten an interview yet they haven't gone well. I got an uphill climb with 'pro poker player' on my resume, but I'll make it this year or next.